common problems acute care Flashcards by Jennifer Rowe

difference in chronic vs acute pain

chronic > 6 months

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management of metastatic bone pain

bisphophonates - prevent development of cancer induced bone lesion as well

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WHO ladder pain of management

3 step progressive ladder
start with ASA/ACE/NSAID
continues to build with heavier narcotics while maintain first step

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pressure ulcers

stage 1: intact skin, doesn’t blanch
stage 2: partial-thickness loss with exposed dermis, blisters
Stage 3: full-thickness kin loss; adipose visible
Stage 4: full-thickeenss skin and tissue loss, exposed fascia, muscle, tendon, ligament, cartilage or bone

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reliable factor for pressure ulcer development

hypoalbuminemia

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initial treatment of post-op fever

hydration and measures to expand lung inflation

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dressing for ulcer that is weeping

hydrocolloid

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WBC shift to the left

bandemia
appear first at site of infection

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complication of enteral support

enteral- directly to stomach NG/ND tube

refeeding syndrome
dehydrtation
aspiration
diarrhea
hypernatremia
emesis
GI bleed

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refeeding syndrome

hypophosphatemia
hypokalemia
hypomagnesemia
hypocalcemia
thiamine deficiency

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ND tube

small bore duodenal tube - if at risk for aspiration

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s/s salicylate OD

( ASA )
tinnitus
hyperthermia
metabolic acidosis
elevated LFTs

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s/s organophosphate OD

(insecticide)
blurred vsion
miosis (constriction)
bradycardia

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drug of choice for organophosphate OD

atropine

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serotonin syndrome mtg

dantrolene sodium
clonazepam for rigor
cooling blankets

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mtg of ethylene glycol OD

(antifreeze)
Fomepizole (Antizol)

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tx of beta blocker OD

glucagon

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what indicates compartment syndrome an need for fasciotomy

intra-compartmental pressure > 30mmhg
measured with Stryker tonometer

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delta pressure

perfusion pressure of a compartment
DBP -ICP ; delta <=30 indicates need for fasciotomy

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mtg of dog/cat/human bite

flush wound
3-7 day course of oral prophylactic antibiotic (augmentin)

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what is the pathogen found in acute otitis media

S.pneumoniae

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what infection is S. pneumoniae related to

acute otitis
sinusitis
bronchititis
meningitis
CAP

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most effective anti-rejection regimen

Triple Therapy
1. cortciocosteriod :prednisone/methylprednisolone
2,. antimetabolite (azathioprine or mycophenolate)
3. calcineurin inhibitor : tacroliums or cyclosporine -OR- mTOR inhibitor

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tx if you feel pt is having acute rejection

immediate biopsy

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s/s acute rejection of organ

immediate failure of that organ flue like s/s

shingrix recommendations

all adults >= 50 y/o- two doses with 2nd dose given 2-6 months after initial dose

how does shingles begin

pain along dermatomal distribution, usually on trunk then grouped vesicle eruption of erythema and exudate

firm irregular papules or nodules may be keratootic and scaly bleeding

squamous cell carcinoma

the most common skin cancer

basal cell carcinoma

waxy , pearly lesion with telangiectatic vessels

basal cell carcinoma

highest mortality rate of skin cancer

malignant melanoma median age=40 may metastasize to any organ

criteria for brain death

no cranial nerve function normal temp

to redue excessive secretions

scopolamine patches or sublingual atropine otic drops under tongue

most common type of headache

tension headache

when would prophylactic therapy be appropriate for migraine

if they occur more than 2-3x /month

what test rules out spyhillis

VDRL

types of prophylactic therapy for migrains

gabapentin amitriptyline botox atenolol topiramate

headache mostly affecting middle aged men

cluster headache

headache unilateral that occurs at night and has rhinorrhea

cluster headache

what helps distinguish renal from non-renal causes of hyponatremia

urine sodium - urine >20 suggests problem with kidney ruine <10 usually problem other than kidney

isotonic hyponatremia

serum osmolality 284-295 (high) occurs with extreme hyperlipidemia or hyperproteinemia

high osmolality is high or low concentration

high - thick like syrup

hypotonic hyponatremia

serum osmolality <280 (diluted body fluid)

causes of hypovolemia with urine Na <10

dehydration diarrhea (c-diff) vomiting (NGT suction)

hypovolemic hyponatermia with urine NA >20

diuretic ACE inhibitor mineralcocortcoid deficiency

hypervolemic hypotonic hyponatremia

need to restrict water- most common edema state CHF liver disease advance renal failure

this electrolyte abnormality is usually from HHS

hypertoni hyponatremia with hyperglycemia osmolality >290, Na <135

tx for hyponatremia associated with hyperlipidemia

cut down fat isotonic hyponatremia

serum osmolality associated with isotonic hyponatremia

high - 284-295

serum osmolality associated with hypotonic hyponatremia

low <280 water excess diluting fluid

most common cause of serum osmolality >290 and hyperglycemia

HHS

mtg of hyponatremia

NS if hypovolemic hypervolemic- restrict water if urine sodium >20 tx cause if symptomatic give NS with loop diuretic CNS s/s give 3% NS with loop diuretic

how do you administer 3% saline

slow and calculated

alkalosis is associated with what electrolyte imbalance

hypokalemia

hyperkalemia is associated s/e of this medication

NSAID

emergency tx of hyperkalemia

Insulin 10U with one amp D50

EKG changes with hypokalemia

broad T wave prominent U waves PVCs

when do you replace potassium with IV supplement

<2.5 or severe s/s presnt may have 40mEq/L/hour IV check Mg

causes of hypocalcemia

hypoparathyroidism hypomagnesemia pancreatitis renal failure severe trauma multiple blood transfusions

s/s hypocalcemia

Trousseaus's sign Chvostek's sign prolonged QT interval increased DTRs

mt of acute hypocalcemia

IV calcium gluconate

ventilator changes for respiratory acidosis

increase rate

pt has low serum bicarbonate, what do you expect on ABG

metabolic acidosis

reasons for increased anion gap

DKA alcoholic ketoacidosis lactic acidosis

ionized calcium is affected how by albumin

it is not - does not vary with albumin (ionized calcium)

emergency tx of hypercalcemia

calcitonin

acid-base imbalance that results from decreased alveolar ventilation

respiratory acidosis

ABG 7.46 and pC02 30, what is this

respiratory alkalosis

first ABG abnormality when in distress

resp. alkalosis

hallmark sign of metabolic acidosis

low serum bicarbonate

s/s of resp. acidosis

somnolence and confusion myoclonus with asterixis

s/s respiratory alkalosis

paresthesia stocking/glove tingling tetany if very severe

Anion Gap

[ (NA) + (K) ] - (HCO3 + CL ) normal 12-17

normal anion gap metabolic acidosis

diarrhea ileostomy renal tubular acidosis

acid-base imbalance characterized by high plasma HC03

metabolic alkalosis

medication mtg for metabolic alkalosis

acetazolamide

first degree burn

dry, red, no blisters , epidermis only

second degree burn

partial thickenss moist, blisters, beyond epidermis

third degree burn

full thickenss dry, leathery, black, epidermis to dermis to underlying tissue, fat, muscle

rule of nines

each arm = 9 each leg = 18 thorax = 18 front, 18 back head = 9 perineum/genitals = 1

parkland formulat

4ml/kg x TBSA % 1/2 fluid in 8 hours, remaining over next 16 hours

avulsion

bone fragments pulled off by attached ligaments and tendons

assessment of eye- how do you know if artery or vein

arteries are brighter red and narrower than veins ; A:V ratio= 2:3 or 4:5

burn center tx criteria

-2nd degree >10% -burns on face, hands, feet, genitalia, perineum or major joints - 3rd degree burns -electircal burns -chemical burns -inhalation injury -burn in pt with medical disorder sth could complicate recovery or affect mortality -any pt with burn and trauma -burned children in hospital without pedi -burn injury in pt that requires special social, emotional or rehab intervention

AV nicking is sign of what

chronic HTN

what does intense pain in eye with redness and tearing from trauma possibly indicate

corneal abrasion

difference in acute closed angle and open angle chronic glaucoma

closed angle has extreme pain

normal IOP (intraocular pressure)

10-20

pt has halo around lights, blurred vision and denies pain - what do you suspect

cataract

tx of open angle chronic glaucoma

prostaglandin analogs (latanoPROST, bimatoPROST, travoPROST)

most common surgery in 65 year olds

cataract sx

glaucoma

increased IOP

viral load should be what in AIDS

zero or undetectable

testing for HIV

HIV1/2 antigent/antibody combo immunoassy ; if postive proceed to HIV-1HIV-2 antibody differentiation immunoassay

testing to monitor HIV

CD4 count normal 500-1200

heberdens nodes

in OA distal IP joint

bouchards nodes

in OA proximal IP joint

RA is worse when

in the morning, better as day progresses

ulnar deviation

hand deviates outward in RA (toward ulnar bone)

what do you monitor with pt on methotrexate

LFT

pt presents with butterfly rash- what do you suspect

systemic lupus erythematosus (SLE) typically woman of childbearing age

dx for SLE (lupus)

ANA ( + in 95% ) antiphospholipid antibodies anemia leukopenia and thrombocytopenia

rcopeniain which age group do you expect to see sarcopenia

decreased muscle mass and strength -lean muscle replace by fat in elderly